Background: Diabetes is global health burden of disease that requires life-long pharmacological and non-pharmacological management to prevent complications such as cardiovascular disease, retinopathy, nephropathy, and neuropathy. Treatment of type 2 diabetes is based on an interplay of patient characteristics, severity of hyperglycemia and available therapeutic options. Metformin, sulfonylureas (SU) and DPP IV inhibitor are the most studied of the oral medications used worldwide. They play a prominent initial role in the type 2 diabetes treatment algorithm recommended by the several guideline. The growing evidence on new technologies and therapeutic interventions is rapidly expanding our knowledge and ability to manage diabetes and its complications; at the same time, however, it is challenge for physicians to select appropriate medication in appropriate dose for optimal patients care. Objectives: To compare the safety and efficacy of the dipeptidylpeptidase-4 (DPP-4) inhibitors combination with other oral hypoglycaemic agent(s) in patients with type 2 diabetes and inadequate glycemic control. Materials & method: Study was conducted among 600 patients over a period of 24 months. All the patients were adult male and female type 2 diabetic patients who received regular oral anti-diabetic drug(s) and duration of T2DM for one year or more were enrolled for study. Total 150 cases were selected. Patients with Type 1 DM, pregnant women with DM and who was receiving injectable antidiabetic medications were excluded from this study. Detail demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigations were done. Main outcome variable was Glycemic status (HbA1C, FBG, 2HABF). Effectiveness of drugs was evaluated by glycaemic status of the patients. Result: Maximum number of patients (38.5%) was between 31-40 years age group with mean age 37.8±9.5 years. Present study shows that, for good glycemic control, all three results (FBS, 2H ABF and HbA1c) were within targeted level in majority patients of DPP4 Inhibitor combination group. Although FBS was best result in metformin group. About 51.9% of SUs group achieved the glycemic control targets level. In case of metformin group it was in 59.8% of patients, and in combined therapy 67.1% patients shows good glycemic target. So DPP4 Inhibitor combination is better medication than other to maintain good glycemic status in type 2 DM patient, due to maximum number of patients reached all three components of result within target range. Conclusion: Diabetes is chronic illness. Good glycemic control with choosing appropriate anti-diabetic medication is pivotal for DM management. In this study it is observed that DPP4 Inhibitor combination group of drug is better than other anti-diabetic medication to maintain good glycemic status in type 2 DM patients. Bangladesh J Medicine July 2019; 30(2) : 63-70

Background: Fever is a common clinical presentation of a number of diseases. A sustained unexplained fever >38.3°C lasting for >3 weeks without an established diagnosis despite intensive diagnostic evaluation is referred to as Fever of Unknown Origin (FUO). Fever more than three week remains a clinical challenge for physicians, as it may be attributed to a wide range of disorders, mainly infections, malignancies, non-infectious inflammatory diseases and miscellaneous diseases. The evaluation of the condition of a patient with fever of unknown origin requires a knowledge of those disorders that produce this syndrome, an awareness of the potential significance of subtle findings in the history and physical examination, and an appreciation of the value in this clinical setting of specific diagnostic procedures. In this report, we review these aspects of fever of unknown origin and outline a diagnostic approach to the persistently febrile patient. Objective: Purpose of this study was to clinico-pathological evaluation of fever more than three weekswith its aetiology and clinical spectrum. Methods: This cross-sectional study was conducted amongst adult males and females patients suffering from the fever of more than three weeks over period of two years at Combined Military Hospital, Chattogram Cantonment from January, 2016 to December, 2017. Sample was selected by purposive sampling technique. Inclusion criteria were H/O fever or body temperature greater than 38.3°C on several occasions, accompanied by more than three weeks of illness and failure to reach a diagnosis after one week of inpatient investigation. Total 72 cases were enrolled according to selection criteria. Routine hematological, biochemical, imaging test were done and mid-stream urine samples were collected from these patients and subjected to culture. Detail demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigation were done meticulously. Results: In this study age of participants at entry was >20years, mean age was 38.04±11.08. Female sex were significant number, sex ratio (F: M) was 1.25:1. Most common clinical presentations were persistent fever and generalized weakness (100.0%), followed by arthralgia/ arthritis (51.3%) anorexia (44.4%) and headache (34.7%). The focused fever of unknown origin diagnostic approach is based on hallmark clinical features characteristic of each disorder. Diagnostic significance of nonspecific clinical findings is enhanced when considered together. Of the infectious diseases that are associated with FUO, tuberculosis (Especially in extrapulmonary sites) was most common cause (eg. 13.8%) and in malignant aetilogy, lymphoma was the major cause (eg. 11.1%) of fever of unknown origin. Abdominal and or Pelvic abscesses (5.6%) Colorectal carcinoma (5.6%) Drug-induced fever (4.1%) UTI (5.6%) SLE (5.6%) Rheumatoid arthritis (9.7%) Dental abscesses (2.7%) and Osteomyelitis (4.1%) were the others common cause of fever of unknown origin. Conclusion: Fever is a common presenting complaint in hospital admitted patients. Most febrile illnesses either resolve before a diagnosis can be made or develop distinguishing characteristics that lead to a clinical dilemma. Fever of Unknown Origin (FUO) is dynamic in its origin and will be an ongoing challenge to the clinician because of shifting disease epidemiology. In this study infection was predominant aetiology for febrile illness. Proper evaluation, rationale use of drugs and health awareness reduced the burden of Fever of unknown origin. Chatt Maa Shi Hosp Med Coll J; Vol.17 (2); Jul 2018; Page 6-13

Introduction: The seronegative arthritis is a heterogeneous group of inflammatory rheumatic diseases with predominant involvement of axial, peripheral joints and enthesitis. All of these have some distinct as well as some overlapping features, characteristic peripheral asymmetrical lower limb involvement and a negative rheumatoid factor. Involvement of joints is usually oligoarticular but rarely polyarthritis may be present. Diagnosis is usually made from clinical features rather than investigations. Objective: To evaluate the seronegative arthritis clinicopathologically by collecting and analyzing the relevant informations. Materials and Methods: A descriptive cross-sectional prospective study was conducted at Combined Military Hospital, Chittagong from November 2015 to October 2016. A total 74 patients of suspected seronegative arthritis were included. Detail socio-demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigations were done meticulously to confirm the aetiology of seronegative arthritis. Results: Maximum number of patients was in the 3rd to 4th decade (62.1%), mean age of the patient was 37.4±8.7 and 38.7±8.1 years in male and female respectively. Malefemale ratio was 2.65:1. Symmetrical sacroiliitis was found in 15(20.2%) patients, asymmetrical sacroiliitis in 36(48.6%) and in 23(31.2%) cases sacroiliac joint was not involved. Common aetiology for seronegative arthritis showed that, reactive arthritis recognized in majority of patients 29 (39.1%) and second most common cause was seronegative rheumatoid arthritis in 23(31%) patients. Conclusion: The Seronegative arthritis is a social, economical and health-care burden. Patients who develop 66 JAFMC Bangladesh. Vol 12, No 2 (December) 2016 arthritis have high disability, discomfort and loss of quality of life. Seronegative arthritis is an interesting group of related conditions with overlapping features and genetic and familial association. That may alert the primary care physician to attain possible diagnosis of spondyloarthritis and to consider a rheumatological opinion. Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 66-70